Constance Chamberlain Wise

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9367 Issued in TN

Practice address

4300 Dayton Blvd
Chattanooga, TN 37415

Phone

(423) 875-5302

Fax

(423) 875-0461

NPI assigned

Dec 22, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Connie Chamberlain Professional name

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1699044487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 DAYTON BLVD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37415",
            "telephone_number": "423-875-5302",
            "fax_number": "423-875-0461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 DAYTON BLVD",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37415",
            "telephone_number": "423-875-5302",
            "fax_number": "423-875-0461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "CONSTANCE",
        "middle_name": "CHAMBERLAIN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-22",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "9367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CONNIE",
            "last_name": "CHAMBERLAIN",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Angelia D Winton, FNP
• Shawn Winton, LPC/MHSP
• Jaime A Wirth, CO
• Rita K Wirth, CRNA
• Wisdom Within Counseling PLLC
• Rachel Wise, PMHNP-BC
• Madison Wisley, ATC
• Joseph Marion Wisniewski, MD
• Janson Alexander Witcher, PA
• Laura E Witherspoon, M.D.

• General Practice Dentistry in Chattanooga, TN
• Providers in Chattanooga, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.